Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, 34093, İstanbul, Turkey.
Ann Nucl Med. 2021 Feb;35(2):270-277. doi: 10.1007/s12149-020-01570-8. Epub 2021 Jan 5.
This study sets out to evaluate patients with increased uptake in breast lesions on Ga-DOTATATE PET/CT (DOTA PET) and determine the clinical significance of somatostatin receptor (SSTR) positive breast lesions.
We retrospectively evaluated all patients with increased SSTR uptake in breast lesions on DOTA PET. Patients with physiological (e.g., lactation) or normal variant breast uptake (e.g., mild diffuse glandular uptake) were excluded. The maximum standard uptake value (SUVmax) was calculated using a manually drawn region of interest in the most intense uptake of breast lesions. All lesions were correlated with breast imaging, including mammography and ultrasonography. Histopathological correlation was performed if the lesion was suspicious for malignancy. Lesions were followed up radiologically (1-8 years).
Out of 1573 retrospectively analyzed DOTA PET scans, the incidence of SSTR + breast lesions was measured as 1.1% (n = 18); however, 4 of 18 patients were excluded due to the lack of final diagnosis of lesions. The median age was 35 (range 14-58 years), and all patients were female. The median SUVmax of SSTR + breast lesions was 5.2 (range 1.5-12.6) for a total of 14 patients. Twelve patients had a single SSTR + breast lesion, while 2 patients had multiple SSTR + lesions on bilateral breasts. In 6 patients, single SSTR + lesions were considered as fibroadenoma; in 2 patients, multiple SSTR + lesions were considered as metastases of NET, based on correlative breast imaging. In 6 patients, histopathological confirmation was needed for the final diagnosis. Histopathologic findings confirmed fibroadenoma in 4 patients by biopsy, in 1 patient with surgical removal of the lesion. The last patient who had a history of IDC was diagnosed with a recurrence of IDC with biopsy. The median SUVmax was 5.1 (range 1.5-9.4) for malignant breast lesions and 5.4 (range 2.2-12.6) for benign breast lesions.
SSTR + breast lesions on DOTA PET are rarely seen in clinical practice. Uptakes of breast lesions in our cases were variable and not useful for differential diagnosis of lesions. It seems that SSTR + breast lesions should be evaluated with clinical and radiological characteristics, and correlative breast imaging and/or histopathological verification should be performed for suspicious lesions to avoid misdiagnosis.
本研究旨在评估 Ga-DOTATATE PET/CT（DOTA PET）上摄取增加的乳腺病变患者，并确定生长抑素受体（SSTR）阳性乳腺病变的临床意义。
我们回顾性评估了所有在 DOTA PET 上摄取增加的 SSTR 乳腺病变患者。排除生理性（如哺乳期）或正常变异乳腺摄取（如轻度弥漫性腺体摄取）的患者。使用乳腺病变摄取最强烈部位的手动绘制感兴趣区计算最大标准摄取值（SUVmax）。所有病变均与乳腺影像学（包括乳房 X 线摄影和超声）相关联。如果病变疑似恶性，则进行组织病理学相关性检查。对病变进行影像学随访（1-8 年）。
在回顾性分析的 1573 例 DOTA PET 扫描中，SSTR+乳腺病变的发生率为 1.1%（n=18）；然而，由于缺乏病变的最终诊断，其中 4 例被排除。中位年龄为 35 岁（范围 14-58 岁），所有患者均为女性。14 例患者的 SSTR+乳腺病变 SUVmax 中位数为 5.2（范围 1.5-12.6）。12 例患者有单个 SSTR+乳腺病变，而 2 例患者有双侧乳房多个 SSTR+病变。6 例患者的单个 SSTR+病变被认为是纤维腺瘤；2 例患者的多个 SSTR+病变被认为是 NET 的转移，基于相关的乳腺影像学。6 例患者需要进行组织病理学检查以明确最终诊断。组织病理学检查结果证实 4 例患者的活检为纤维腺瘤，1 例患者为病变的手术切除。最后 1 例有 IDC 病史的患者被诊断为 IDC 复发，经活检证实。恶性乳腺病变的 SUVmax 中位数为 5.1（范围 1.5-9.4），良性乳腺病变的 SUVmax 中位数为 5.4（范围 2.2-12.6）。
DOTA PET 上的 SSTR+乳腺病变在临床上很少见。我们病例中的乳腺病变摄取情况各不相同，对病变的鉴别诊断没有帮助。似乎 SSTR+乳腺病变应根据临床和影像学特征进行评估，并对可疑病变进行相关的乳腺影像学和/或组织病理学验证，以避免误诊。
